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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> · 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:588-5147 8:00-4:30 <br /> · 24 HOUR ~ODE-A-PI-IONE: 588-7904 <br /> <br />I >~ ) I am performing work on a proper y I own or OCCUpy <br /> ) <br /> I am a registered builder OR the authorized repiesenta ye <br /> of a registered builder, : <br /> ) The work will be performed by a registered builder,: <br /> Other ............. <br /> I have read and agree to the terms stated on the reverse side of <br /> this document, <br /> <br />PE~RCE, CH~Rt.,ES ~ <br />AIJ~SV~LI._E O~k 97~25 ~ MARION COUNT~ NO <br /> <br /> oAHL <br /> PHONE: 3~-,,6954 j VALUATION: <br /> <br /> ~ : 3.9', AC ~ F O NO <br /> <br />TYPE= ON-SITE SEWAGE <br /> <br />PER,lIT OR APPLICATION NO= <br /> <br />ISOI,II'RA C T,O.,R, <br />PEARCE, [,HARLES <br />SAME <br /> <br />PHONE: <br /> <br /> ITE~ <br />AUTHORIZATION NOTICE - FLD. <br /> <br />PAYEE: PEARCE~ CHARLES <br />RECEIVED BY." CL, <br /> <br /> WATER SUPPLY <br /> I'EST HOt. ES READY: <br /> SITE EVALUATION NUHBER: <br /> EXISTING TANK SIZE: <br /> EXISTING DRAIN FIELD LINES: <br /> SEPTIC TANK PUMPED: <br /> PREVIOUS NO. ~EDROOMS: 5 <br /> <br /> QUANT I TY AMOUNT <br /> <br /> TOTAL. ASCENDED FEES ¢1~8.88 <br /> PRE~IQUS RECE~F'T~ $~. g~ <br /> THIS RECEIPT. $168. B~ <br /> <br /> RECEIPT NO: 55943 <br />...................... TYPE: CE 6NECK ~,: 4667 <br /> <br /> SEE ATTACHED DOCOMEHT FOR 'REQI IREMENT$ OF ON-SITE SEWAGE SYSTEM. <br />AI_LFOI-'L'OW]:I~GNECESSARyMIJSTINFORMATIoHBE gONPLETEg,HAS ~[' ENISPROVIDED.THE RESPONSIBILITY OF THE APPLICAHT TO ASuURE THAT <br /> <br />OFFICE COPY <br /> <br /> <br />